Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors patient charts and records to evaluate care concurrent with the patients treatment. Being a Utilization Review Coordinator reviews treatment plans and status of approvals from insurers. Collects and complies data as required and according to applicable policies and regulations. Additionally, Utilization Review Coordinator consults with physicians as needed. May require a bachelor's degree. Typically reports to a supervisor. Typically requires Registered Nurse(RN). The Utilization Review Coordinator contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. To be a Utilization Review Coordinator typically requires 4 to 7 years of related experience. (Copyright 2024 Salary.com)
Job Description
Duties and Responsibilities :
Initial authorizations of outpatient physical therapy services : Reviews and authorizes services that meet criteria, along with supporting documentation.
It is the responsibility of the URC to ensure outpatient physical therapy services are provided at the appropriate level and are received per the defined plan guidelines.
Will facilitate all Care Management related communications being sent to the member.
Additional responsibilities include :
Qualifications and Experience :
Individual must be results and goal oriented. Must be self-directed and can communicate effectively, both orally and in writing.
Computer experience required : Word, Excel, Internet.
Education :
Healthcare professional with an acquired background in physical therapy. Must possess an Associate's Degree, Bachelor’s degree preferred.
Experience in lieu of a degree will be considered.
Company Description
Exceptional Customer Service starts with having team members who understand and embody collaboration and team work. It continues every day with a positive, problem-solving approach to any issues or concerns - regardless of how small and with continued expression of appreciation for our team.
What we do is so important. Interested in joining us in that mission?
Exceptional Customer Service starts with having team members who understand and embody collaboration and team work. It continues every day with a positive, problem-solving approach to any issues or concerns - regardless of how small and with continued expression of appreciation for our team.
What we do is so important. Interested in joining us in that mission?
Last updated : 2024-03-23
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